double-blind, placebo-controlled trials are needed to evaluate the efficacy and safety of oral hepatitis B antiviral therapy in eliminating perinatal HBV transmission from women at high risk for perinatal transmission. Although an increasing number of effective HBV antiviral suppressive medications have become available for the management of chronic HBV infection, very little research has been done on the use of these medications during the last trimester of pregnancy to eliminate the risk of perinatal transmission, particularly in the high-risk population of women who test positive for HBeAg or have a high HBV load.

Recommendation 5-7. The National Institutes of Health should support a study of the effectiveness and safety of peripartum antiviraltherapy to reduce and possibly eliminate perinatal hepatitis B virustransmission from women at high risk for perinatal transmission.

Correctional Settings

Incarcerated populations have higher rates of both HBV infection and HCV infection than the general population. Correctional facilities present a unique opportunity to bring viral hepatitis services to at-risk populations. The period of incarceration is opportune for education about hepatitis B and hepatitis C (see Chapter 3). Inmate peer-education programs have been particularly effective for HIV/AIDS education and have also been used for hepatitis education (Simmons, 2004), but relatively few prison systems provide such programs (Collica, 2007).

Correctional facilities include both jails and prisons. Jails are operated by county and local jurisdictions and house people who have been arrested and are awaiting trial, people who have been convicted of misdemeanor crimes, and people who have been convicted of felony crimes with short-term sentences (usually less than one year). The length of stay in jail can be a short as a few hours or longer than a year. Prisons are operated by states and the federal government. They house people who have been convicted of felony crimes with sentences generally of one year or longer. A few states have combined systems that include both jail and prison inmates.

The prevalence of chronic HBV infection in correctional settings (prisons and jails) is estimated to be 1–4%, and that of chronic HCV infection has been reported to vary from 12% to 35% (Boutwell et al., 2005; Weinbaum et al., 2003). The high prevalence in this population is not primarily a result of incarceration but rather indicative of people who engage in risky behavior and were in risky settings before incarceration.

Hennessey et al. (2009) looked at HBV-infection and HCV-infection prevalence in jail inmates. They found evidence of past HBV infections in 31% of Asian inmates, 21% of black inmates, 14% of white inmates, and

The National Academies of Sciences, Engineering, and Medicine 500 Fifth St. N.W. | Washington, D.C. 20001